Much of speech therapy involves the clinician guiding the therapeutic process (e. g., presenting stimuli and eliciting client responses). However, this Brief Communication describes a different approach to speech therapy delivery. Clinicians at Waldo County General Hospital (WCGH) use high definition audio and video to engage clients in telepractice using interactive web-based virtual environments. This technology enables clients and their clinicians to co-create salient treatment activities using authentic materials captured via digital cameras, video and/or curricular materials. Both therapists and clients manipulate the materials and interact online in real-time. The web-based technology engenders highly personalized and engaging activities, such that clients' interactions with these high interest tasks often continue well beyond the therapy sessions.