Institutional design for local air quality management is an underdeveloped area for research and practice. Although the United States has more than a century of organizational experience managing air quality at the Federal level, the recent years have seen a surge of interest in addressing municipal-scale solutions. Without information about the institutional designs, governance structures, and implications of localizing air quality management, practitioners may face challenges reducing population exposure to air pollutants. We offer a US national perspective on managing local air quality by assessing and surveying 117 local air quality authorities identified by the National Association of Clean Air Agencies. The results expose many commonalities and differences among local air quality management agencies across the United States. We find that the authority type and motivations for creating the local air quality agency drive much of the organization structure and capacity to fulfill mandates. The results further provide a means for evaluating the opportunities and challenges for creating local air quality agencies, while recognizing the factors that support effective institutional designs.