The premier designate Nikola Gruevski won the support of 68 out of 120 deputies, while 22 voted against.
Seventeen members of the ethnic Albanian party DUI boycotted the vote because they failed to join the new government. Thirteen deputies were absent or abstained.
Gruevski, a 35-year-old former finance minister, led the Conservative VMRO-DPMNE party to the victory in the July 5 elections, promising that his cabinet would revive the Macedonian economy.
Gruevski invited two business people educated in the United States to join the new government and appointed them his deputies in charge of attracting foreign investments.
The unemployment rate in Macedonia is 36 percent.