Twin Hills is primarily accessible by air and water. Regular and charter flights are dispatched from Dillingham. There is a state-owned lighted gravel runway on a ridge east of the village. Most cargo is delivered by air. There is a boat landing area but no docking facilities; bulk goods must be lightered to shore. Cars, ATVs, and snow machines are used for local transportation. Residents drive along the beach to access the Togiak Fisheries cannery. A winter trail for snow machines connects Twin Hills with Togiak.