Despite increasing attention, top management research has been heavily dominated by a focus on private companies with much less emphasis on the top managers in public organizations. We present a systematic literature review of 212 studies focused on public sector top managers published between 2005 and 2020. First, the paper provides descriptive results suggesting that the empirical focus on top managers in the public sector is increasing, though still limited compared to research on upper echelons in private firms. Second, we develop an empirically based “systems” model illustrating the role and function of top managers in public organizations. We use the model to show that the components of top management are interdependent, adaptive, and embedded in complex relationships in the system, and to identify avenues for future research.