Objective: In countries such as the USA, colleges and universities are focusing on how best to serve their students in tough fiscal times and a highly competitive marketplace. Boise State University has specifically focused on providing online courses as one option to meet student needs. However, more recently, the university has begun developing high-enrolment online courses to resolve bottlenecks in enrolments, while maintaining robust, interactive and engaging learning experiences. Design: Mixed-methods case study. Setting: Three high-enrolment health studies online courses offered at a 4-year university in Boise, Idaho, USA. Method: A systemic analysis of final course evaluations, student grades and course reports from the Learning Management System were examined to investigate the effectiveness and student perceptions of high-enrolment online courses. Results: Findings provide support for the premise that offering the high-enrolment courses met enrolment demand, provided high-quality instruction and maintained student satisfaction. Conclusion: Student perceptions of high-enrolment health studies online courses designed and implemented in the manner specified here can be positive. Lesson learned and suggestions for faculty members, instructional designers and administrators are identified.