The United States and Canada, the two tier 2 sides in the North American region, take part in the Rugby Americas Championship, the "Americas 6 Nations", instead but a team representing the United States South regional association, USA South do take part.

The current format of the tournament contains both a geographical and divisional element with promotion and relegation.

All the teams are split between the North and South.

Within that geographical split, teams are then split into the Championship (higher division) and the Cup (lower division).

As of 2017, the Southern region does not have a Cup division.