The widespread introduction of lightweight IT—smartphones, tablets, the Internet of Things, and the growth of third-party app developers—has become a challenge for many organizations. Local units and end-users increasingly are acquiring and implementing lightweight IT outside the realm of the IT function. The trend is driven by competent users’ need for innovative IT services, enabled by the consumerization of digital technologies. Lightweight IT entails exciting business opportunities; however, guidance for managers on how to deal with this development has been very limited. In this paper, we investigate which IT governance models organizations can apply to manage lightweight IT. The managerial challenge is to balance the innovative potential of lightweight IT with the requirements of good governance. Building on the particular challenges of lightweight IT and the extant literature on end-user computing, we present a framework with four alternative governance models. We evaluate the framework through four e-health case studies.