NK cells are an important arm of the innate immune system, and they constitutively express the NKp30 receptor. NKp30-mediated responses are triggered by the binding of specific ligands, such as tumour cell-derived B7-H6, and involve the secretion of cytotoxic mediators TNF-α, IFN-γ, perforins and granzymes. The latter two constitute a target cell-directed response that is critical in the process of immunosurveillance. The structure of NKp30 is presented, focusing on the ligand-binding site, on the ligand-induced structural changes, and on the experimental data available correlating structure and binding affinity. The translation of NKp30 structural changes to disease progression is also reviewed. NKp30 role in immunotherapy has been explored in chimeric antigen receptor T-cell (CAR-T) therapy. However, antibodies or small ligands targeting NKp30 have not yet been developed. The data reviewed unveils the key structural aspects that must be considered for drug design in order to develop novel immunotherapy approaches.