Video games can offer tremendous motivational appeal, making for an attractive option for rehabilitative and therapeutic medicine. However, video gaming alone is not sufficient to ensure that an intervention will be successful. In this talk, we I will discuss cognitive behavioral factors that underlie both video game experiences and therapeutic challenges. We I will use a trio of video games designed for occupational therapy, substance abuse, and vision therapy to explore how some design considerations lead to emergent social factors--pertaining in particular to gender and income--that can significantly affect outcomes. Time permitting, we will also discuss accessibility factors and how they affect access and acceptance of these interventions.