This book constitutes the refereed post-conference proceedings of the 48th International Simulation and Gaming Association Conference, ISAGA 2018, held in Delft, The Netherlands, in July 2018. The 19 revised full papers included in the volume were carefully reviewed and selected from 27 submissions. The contributions to this book range from design thinking related to simulation gaming, the analysis of the consequences of design choices in games, to games for decision making, examples of games for business, climate change, maritime spatial planning, sustainable city development, supply chain, and much more.