Pretend play has been claimed to be crucial to children’s healthy development. Here we examine evidence for this position versus 2 alternatives: Pretend play is 1 of many routes to positive developments (equifinality), and pretend play is an epiphenomenon of other factors that drive development. Evidence from several domains is considered. For language, narrative, and emotion regulation, the research conducted to date is consistent with all 3 positions but insufficient to draw conclusions. For executive function and social skills, existing research leans against the crucial causal position but is insufficient to differentiate the other 2. For reasoning, equifinality is definitely supported, ruling out a crucially causal position but still leaving open the possibility that pretend play is epiphenomenal. For problem solving, there is no compelling evidence that pretend play helps or is even a correlate. For creativity, intelligence, conservation, and theory of mind, inconsistent correlational results from sound studies and nonreplication with masked experimenters are problematic for a causal position, and some good studies favor an epiphenomenon position in which child, adult, and environment characteristics that go along with play are the true causal agents. We end by considering epiphenomenalism more deeply and discussing implications for preschool settings and further research in this domain. Our take-away message is that existing evidence does not support strong causal claims about the unique importance of pretend play for development and that much more and better research is essential for clarifying its possible role.