NACCHO is governed by a 33-member Board of Directors, comprising health officials from around the country elected by their peers, a representative for Tribal health departments, and including ad hoc members representing the National Association of Counties and the U.S. Conference of Mayors.  The NACCHO Executive Committee includes the four NACCHO officers and the chairs of the three NACCHO forums—the Metro Forum, County Forum, and City Forum.

The Board meets three times a year: at a Leadership Meeting in Washington, D.C., at the NACCHO Annual Conference, and in conjunction with the APHA Annual Meeting.

NACCHO members have opportunities to serve on a variety of NACCHO advisory gropus, including standing committees and program advisory groups. Most groups meet by conference call and have one face-to-face meeting a year.