How does organizational structure shape the role of leadership? Research emphasizes the negative implications of broad spans of control, but theory and empirical research about the span of control and leadership are sparse. We develop theoretical arguments about the span of control and transformational, transactional, and distributed leadership and argue that employees in units with medium-sized spans of control observe more leadership and have higher job satisfaction. Furthermore, that span of control can affect leadership behaviors differently. The arguments are tested on multilevel survey data from 393 nursing managers and 1699 nurses in Danish hospitals. We find that employees experience more leadership behavior and higher job satisfaction under medium spans of control compared to narrow and broad spans of control. Consequently, span of control should still be considered an important aspect of organizational design when active leadership behavior and high employee job satisfaction are warranted.