This paper addresses a fundamental problem in random variate generation: given access to a random source that emits a stream of independent fair bits, what is the most accurate and entropy-efficient algorithm for sampling from a discrete probability distribution $(p_1, \dots, p_n)$, where the probabilities of the output distribution $(\hat{p}_1, \dots, \hat{p}_n)$ of the sampling algorithm must be specified using at most $k$ bits of precision? We present a theoretical framework for formulating this problem and provide new techniques for finding sampling algorithms that are optimal both statistically (in the sense of sampling accuracy) and information-theoretically (in the sense of entropy consumption). We leverage these results to build a system that, for a broad family of measures of statistical accuracy, delivers a sampling algorithm whose expected entropy usage is minimal among those that induce the same distribution (i.e., is "entropy-optimal") and whose output distribution $(\hat{p}_1, \dots, \hat{p}_n)$ is a closest approximation to the target distribution $(p_1, \dots, p_n)$ among all entropy-optimal sampling algorithms that operate within the specified $k$-bit precision. This optimal approximate sampler is also a closer approximation than any (possibly entropy-suboptimal) sampler that consumes a bounded amount of entropy with the specified precision, a class which includes floating-point implementations of inversion sampling and related methods found in many software libraries. We evaluate the accuracy, entropy consumption, precision requirements, and wall-clock runtime of our optimal approximate sampling algorithms on a broad set of distributions, demonstrating the ways that they are superior to existing approximate samplers and establishing that they often consume significantly fewer resources than are needed by exact samplers.