The past decade has witnessed the rise of simulations-based clinical trial optimization in a manner unimaginable to most only a few years ago. Such optimization has become an integral aspect of strategic clinical trial design. The initial techniques of operationalizing Monte Carlo methods within a study design setting have increased and transformed in the landscape of cloud-powered computing. Nowadays, technology can produce innumerable simulations within a short space of time. Cytel’s Solara, for example, recently ran 1.5 million simulations within a fifteen minute period to identify trial designs optimized over speed, trial cost and probability of success. Why is it then, that some trial sponsors still struggle to make use of such simulations?