There seems to be an increasing patient demand for immediately accessible virtual medical visits via the Internet. Although provision of this service has proliferated, little is known about the quality of care delivered by these models. This audit study used trained standardized patients—"secret shoppers"— to present common acute illnesses to the eight most popular commercial virtual visit websites. Physicians correctly named diagnoses in 77% of the visits, but key management decisions complied with guidelines in only about half of cases. The quality of care provided varied widely across websites. Virtual visit physicians frequently prescribed antibiotics inappropriately, though this is also true in traditional clinic settings. Conversely, physicians generally did not order additional testing, even when it would be recommended by guidelines, such as in ankle pain cases with specific concerning signs. These findings call for further study to understand these emerging models of care delivery and specific opportunities to improve quality and safety in these settings.