The Church is expressed primarily in the congregation but is also manifested in wider structures that serve the ministry of the local congregation. Oversight in the Church has been fundamental since New Testament times. The NALC is served by a bishop, and by regional pastors who will are called deans. Both men and women may serve in all offices of the church.

The bishop, a title which means overseer, provides oversight of the North American Lutheran Church. The Augsburg Confession, Article 28, teaches that the office of the bishop is to preach the Gospel, forgive sins, judge doctrine and condemn doctrine that is contrary to the Gospel. Consistent with that Confessional understanding, the bishop of the NALC is charged to proclaim the Gospel, administer the Sacraments, defend the faith, foster the mission of the Church, ordain or make provision for ordination, participate in the application of discipline, visit congregations, engage in ecumenical relationships, and provide counsel and assistance in the call process.

The deans embody this oversight in a particular geographical region which is established as needed. Regional geographical units, intended to be small and local, may be formed to assist congregations in working together for mission. They elect a dean who will serve as pastor to pastors, their families, and congregations and will emphasize teaching the faith and visitation with pastors and congregations. Deans may continue to serve under the call of a congregation. The deans are accountable to the bishop, and support the work of the bishop by conducting similar functions in their respective geographical areas except that they will not be responsible for any disciplinary proceedings.

The bishop of the church installs the bishop-elect. Deans are installed by the bishop or, at his/her behest, another dean. Pastors are normally ordained by the bishop or a representative appointed by the bishop. A candidate for the ministry may submit a request to the bishop to appoint a particular pastor to preside at the ordination, which shall be approved absent extraordinary circumstances.

If the office of the bishop is vacant, the executive council appoints a pastor-administrator who will serve until the election of a new bishop. This officer performs the duties of the bishop including presiding at meetings of the executive council and the Convocation.

The national organization serves the ministry of the entire church with the understanding that the congregation is the primary locus of ministry and mission. The structure of the national church follows the rule that form follows function.