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The Reverend Canon Gene Robinson, of New Hampshire, was approved by a substantial majority of the Episcopal Church's House of Deputies, composed of clergy and lay people.
The vote must be confirmed by the House of Bishops tomorrow, but correspondents say it is likely this vote will also be in favour of Mr Robinson.
The decision has brought an angry reaction from conservatives and religious leaders in the US and all over the world.
Some have already threatened to walk out if the vote goes in Mr Robinson's favour, and join a breakaway faction with supporters from Africa, Asia and the Caribbean outside the Anglican Convention.
Mr Robinson described himself as "calm but joyous" after the vote, and said he hoped the decision would lead to growth rather than a split in the church.
"I think I can do more for gay and lesbian folk in the Church by being a good bishop than by being the gay bishop," he said.
Mr Robinson is a divorced father of two and has lived with his male partner for 14 years.
He is highly popular with his New Hampshire congregation, who elected him bishop from a wide range of candidates.
His supporters have also stood by him throughout the storm his appointment has stirred up, and simply ask that he should be judged and celebrated for the work he does.
'Church could split'
Religious leaders in the UK have also warned that the decision could split the Church of England.
Reverend David Phillips, general secretary of the Church Society, challenged the Archbishop of Canterbury, Dr Rowan Williams, to say where he stood on the issue.
"People want to know where the Church of England stands," he said. "I would like him to say that, because of its decision, the Episcopal Church in America is no longer a part of the Anglican Communion."
A spokesman for the Church of England said the appointment was considered an internal matter for the Episcopal Church in the United States.
The Anglican Church has traditionally tolerated a wide spectrum of beliefs, and its communion includes about 80 million people worldwide.
But the current controversy seems likely to stretch the elastic nature of the church to breaking point.
The vote by the House of Bishops to confirm Gene Robinson's appointment was delayed after allegations of sexual misconduct were made against him.
The charges were dropped, and on 5 August - a day late - the House of Bishops voted for the Anglican Church's first openly gay bishop by a two-thirds majority.
An emergency meeting of Anglican Church leaders at Lambeth Palace in October 2003 strongly rebuked the American Episcopal Church for the appointment, but stopped short of expelling the church outright.
Gene Robinson was consecrated in November 2003, amid further objections voiced during the service, and took up his post in March 2004.
There was a similar crisis in the Church of England, when celibate gay priest Canon Jeffrey John was forced to step down shortly after his appointment as Bishop of Reading.
Protests at the way he was treated led to his appointment to the high-profile job of Dean of St Albans, and he was installed in July 2004.
A number of evangelical churches withdrew funding from the diocese in protest.
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