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While the use of performance-based assessments in medical schools is widespread, there are unique issues associated with developing and establishing simulated clinical examinations when resources are limited. The faculty at the National University of Cuyo (NUC) in Mendoza, Argentina, has successfully implemented an OSCE as part of the medical school graduation requirements. This paper provides an overview of the issues faced by NUC faculty in setting up a standardized patient (SP)-based assessment with only limited resources, and contrasts their experiences with those of other groups, including certification and licensure bodies who have implemented similar types of assessments. Despite their novelty and a lack of technological, staffing, and budgetary resources, with adequate planning, an emphasis on faculty involvement, quality case development, local SP recruitment and training activities, educational programs focused on assessment, and flexibility in creating a physical space to conduct the exam, an effective program for assessing the clinical skills of medical students can be realized.