Interesting how this compares with the newer Linux Services for Windows.
Your only option at this point is to use a virtual machine. Intel has supported real mode VMs since Sandy Bridge and I'm not sure when AMD got it, but all of the Zen parts definitely support it.
There was a wine derived thing that used to work on Win64 to run win16 apps, but something in later windows versions broke that.
Does that mean winevdm doesn't work anymore?
It was a tradeoff to intentionally break compatibility in a pain point for them where it would be acceptable by their customer base.