How to inject an evaluated expression into a held expression?

Here are a couple of alternatives to Trott-Strzebonski in @R.M's answer:

Hold[{3,4,5|6}] /.
  Verbatim[Alternatives][x__] :> RuleCondition@RandomChoice@List@x

Hold[{3, 4, 5}]

Hold[{3,4,5|6}] /.
  Verbatim[Alternatives][x__] :> Block[{}, RandomChoice@List@x /; True]

Hold[{3, 4, 6}]

They operate on the same principle as Trott-Strzebonski (i.e. RuleCondition), but express the effect in different ways.

This is a case where the Trott-Strzebonski in-place evaluation trick is useful. You use With to inject inside your held expression as:

(Hold[{3, 4, 5 | 6}] /. (Verbatim@Alternatives)[x__] :> 
    With[{eval = RandomChoice@List@x}, eval /; True])

Out[1]= Hold[{3, 4, 5}]

You should definitely read this post by Leonid, that gives you a good insight into how this works, but in short, using Condition or /; forces the evaluation of eval when the condition is True (i.e., always) and then injected arbitrarily deep using With.