Since an energy-efficient home is tightly sealed, it's also important and fairly simple to deliberately ventilate the building in a controlled way. Controlled, mechanical ventilation of the building reduces air moisture infiltration and thus the health risks from indoor air pollutants, promotes a more comfortable atmosphere, and reduces the likelihood of structural damage from excessive moisture accumulation.

A carefully engineered ventilation system is important for other reasons too. Since devices such as furnaces, water heaters, clothes dryers, and bathroom and kitchen exhaust fans exhaust air from the house, it's easier to depressurize a tight house if all else is ignored. Natural draft appliances, such as water heaters, woodstoves, and furnaces may be "back drafted" by exhaust fans and lead to a lethal build-up of toxic gases in the house. For this reason it's a good idea to only use "sealed combustion" heating appliances wherever possible and provide make-up air for all other appliances that can pull air out of the building.

Heat recovery ventilators (HRV) or energy recovery ventilators (ERV) are growing in use for controlled ventilation in tight homes. These devices salvage about 80% of the energy from the stale exhaust air and then deliver that energy to the fresh entering air by way of a heat exchanger inside the device. They are generally attached to the central forced air system, but they may have their own duct system.

Other ventilation devices such as through-the-wall and/or "trickle" vents may be used in conjunction with an exhaust fan. They are, however, more expensive to operate and possibly more uncomfortable to use since they have no energy recovery features to pre-condition the incoming air. Uncomfortable incoming air can be a serious problem if the house is in a northern climate, and they can create moisture problems in humid climates. This sort of ventilation strategy is recommended only for very mild to low humidity climates.