That's right in the US there's still at least one non-RNAV SID or STAR for almost every major airport.

And since there's no FSDO in flight sim to jerk your license away from you if you wander too much it's possible to hand-fly a SID or STAR or do it with heading mode only.  I did for a while flying the 732 in Alaska before I switched to Acceleration and got the autopilot to track the magenta line without it having to be in alt hold mode.

You just have to pay real close attention to what's going on and have the GPS installed in the airplane so you can see the line you're supposed to be following :)

Talk about a challenge...I even managed to keep the RC4 controllers from barking at me most of the time.