The game controls using the Wii-mote for pointer control and the nunchuck for movement. Most of the movements are also mapped to buttons, so if you're having trouble with the motion it won't be a problem. Holding the A button will bring up your iron sights, a kind of sniper mode. Medal of Honor: Vanguard employs a unique leaning system that lets you take cover and shoot while continuing to snipe enemies. Throwing grenades is performed by holding the B button and making a tossing motion with the Wii-mote.

After each campaign you are awarded with medals that reflect your progress during the mission. Your squadmates help by taking down enemies, providing covering fire, and throwing grenades. Your squad mates will also let you know how they think you're doing, with shouts of "Get your head down Keegan", "Nice shot Keegan", "Keegans goin' for a medal", and "Leave some for us Keegan". A few of the operations begin with parachute sequences into enemy territory. You control where you start the battle by directing you parachute to where you want to land.