Surgery programs must strive for educational efficiency to be compliant with current regulations. Teaching technical skills in a simulated environment is particularly suited to surgical training. Published data have shown that simulators are effective tools for improving technical skills in the operating room, and they appear to improve the efficiency of learning new techniques. Simulators can also be used to assess technical competence, which may be helpful in decisions regarding appropriateness of performing operations on live patients, promotion, and even certification. Technical skills models do not have to be costly. Programs can benefit from beginning a technical skills curriculum with inexpensive simulators such as box trainers. Additional models can be added as appropriate for the individual program's need. Regardless of the models chosen, simulator costs are ultimately offset by savings from improved efficiency in the operating room, and ultimately by reduced technical errors. Future directions in technical skills training include development of new simulator models, including realistic simulators for teaching open skills. Residents may one day be selected on the basis of innate ability demonstrated on a simulator. As technical skills assessment becomes a routine part of competency evaluation, surgeons will accept the importance of maintaining their technical skills through practice. The airline industry experience suggests that simulator training will benefit surgery's public image; more importantly, widespread adoption of technical skills training should benefit individual surgeons and their patients.