Although the president has a largely ceremonial position, with some powers to veto legislation, the outcome of the vote could trigger early parliamentary elections in a country deeply polarized between the governing Social Democrats and the opposition VMRO-DPMNE conservatives. Turnout will be crucial, with 40% needed for the election to be valid. The first round barely made it past that point, with a turnout of 41.8%.
Campaigning in the first round centered on a recent deal the Balkan country reached with neighboring Greece to rename itself North Macedonia in exchange for Athens dropping objections to it joining NATO and the European Union. This time round, the candidates have focused more on the issues of corruption, crime, poverty and brain drain.
Here is a look at the two contenders for North Macedonia's presidency.
Gordana Siljanovska Davkova, 63 — The first woman to run for president since the country declared independence from Yugoslavia in 1991. Known for her love of yoga and rock 'n' roll, Siljanovska, a constitutional law professor, first emerged as a non-partisan candidate promoted by her university. Her nomination is now supported by the main conservative opposition VMRO-DPMNE party.
Siljanovska campaigned under the slogan "Justice for Macedonia, fatherland calls." She has been a vocal opponent of the deal with Greece that changed the country's name to North Macedonia and had hinted she would challenge the name agreement in the International Court of Justice in The Hague. But last week, Siljanovska said during a debate on national television MTV she will not "spend the whole mandate in reviewing the name agreement with Greece."
"I will fight for democratization of the undemocratic Macedonian political system," she added.
During a campaign speech, Siljanovska said her country needs a "radical reversal," and described it as being "in many elements a failed state."
Siljanovska served as minister without portfolio in 1992-1994 in the first government after independence and participated in writing the country's first constitution.
Stevo Pendarovski, 56 — A former national security adviser for two previous presidents and until recently national coordinator for NATO, this is Pendarovski's second bid for the presidency after being defeated by Gjorge Ivanov in 2014.
Pendarovski is running as the joint candidate for the governing social democrats and the junior governing coalition partner, the ethnic Albanian Democratic Union for Integration party. His candidacy is also supported by 29 smaller political parties.
He has defended the name deal with Greece, arguing it paved the way for the country to nearly finalize its NATO accession and led to hopes EU membership talks will begin in June.
His slogan "Forward Together" reflects his main campaign platform of unity, and he has made NATO and EU membership a key strategic goal, saying they will bring foreign investment, jobs and higher wages and prevent young people leaving the country.
"People should know what is at stake, they should not stay passive," he said during the television debate. "They have to go out and choose between two concepts - the one that is for progress, cohesion and integration in the strongest international organizations, (and) the other that draws the country back in time."