The device is being recognized, I can see the meter reacting when I play the keys, but I can't seem to choose a correct output or something... in "select MIDI input and output devices" it shows up, the name of the device is in both input and output which seems odd to me... long story short, I can see the input but can't hear the output. I'm using the Presonus USB Audiobox. Any thoughts?

So the midi track shows response from the Akai....that's good....in the same strip the midi out has to be selected to a softsynth....ie session drummer or whatever.....I see no softsynths response from time to time....I just hit play....if a blank project....arm....midi record......pull the USB plug out then insert again....that will usually awake a non responsive softsynth
 
Be aware of softsynths mutes or solo....this causes no response issues.....just last week I done that while re doing a drum track....just take the unwanted midi strip and default the output to an unconnected midi port 

On the strip (and I have to go to track mode) the midi input is set to MPK261 Omni, the output only gives me two choices... MPK261 which is checked, new drum map with a pull down of a million drum options, and drum map manager, I've got "channel" set to 1 General midi, "Bank" doesn't give me any options and it's set to None, and for Patch I've just chosen a harpsichord so it's obvious. On the output I don't see any way to choose Soft Synths, the only place I see a Soft Synths option is on my "audio" tracks.

There are several ways to add synths to a project, this https://www.cakewalk.com/Documentation?product=SONAR%20X3&language=3&help=Tutorial4.2.html describes one way. Synths can also be added by dragging to the project from the plug-in tab browser or using the + in the synth tab of the browser.

Okay, I see, that helps, I now have sound, I'll go back through that string of tutorials as well. Now that I am hearing the output though, I seem to be getting some latency.

To reduce latency, adjust your audio configuration either in the vendor client software for ASIO mode on in Preferences > Audio > Driver Settings for other driver modes.

If anyone knows how to do that in Sonar X3 I'd appreciate it... in the Audio Driver Settings section there is a Mixing Latency section, the "buffers in Playback Queue" is set to 2 and the Buffer size slider is on "fast" at 46.4 msec/2048 samples, but the Queue setting and slider are greyed out so I cannot adjust them. Then is says, Effective latency at 44khz/stereo: 46.4 msec. Below that is the ASIO panel... it says "ASIO Reported Latencies (includes buffer and hardware latencies) Input: 47.4msec. 2092 samples, Output: same, Total roundtrip: 94.9msec. 4184 samples. The ASIO panel button highlights when I click it but nothing happens.

ASIO settings are modified by software which came with your audio interface. The program is usually represented by an icon in the notification area.

Yeah, for the USB Audiobox that's pretty basic... there are only two options, Sample Rate which is set to 44.1 khz (I have the option to change that 48.0 Khz if you think that will make the difference), and ASIO Buffer size, which is set to 2048 (which is the highest setting.)

The ASIO buffer size needs to be set to 128 or smaller while tracking.