Quite often, we do this naturally through our careers. If we are so inclined we could even say destiny is to be found in our 10th house. To understand our Midheaven (MC) sign, we also to have to look at its opposite sign found on the Nadir (IC).
I'll use my chart for example: I have Aries on the 4th house cusp so I carry this warrior spirit deep in my soul and in the comfort of my own home. The house that holds the sign Aries in our chart shows where our battleground is. This is where as Noel Tyl likes to say we need to be numero uno, the champ. In my case it's on the home front and this is re-emphasized by my Aries Moon. Then out of all that chaos at home and deep inside my soul blooms this peace loving, diplomatic kind of artsy persona (Libra Midheaven) that I've strived for all my life. Deep in my soul, I'm a rugged individualist (Aries) who strives constantly for beauty and harmonious relations with others (Libra). Now try this with your own MC/IC axis to get a good feel for how it works. Remember the Midheaven blooms out of the Nadir.
What does a Presidential horoscope look like? I guess you would expect to see a strong 10th house (career and public reputation), but it doesn't necessarily work like that. George Bush's 10th house doesn't stand out to me as particularly presidential; I don't think any astrologer would look at young George's 10th house and declare this young man will one day be President of the United States.
If you look carefully though Bush's 10th house does fit, he has the warrior sign Aries on the Midheaven and Bush will forever be associated with the war in Iraq. His battleground is his public life (10th house). But this public, warrior-like persona blossomed out of a "peace and love" Libran foundation. This is re-emphasized by his Libran Moon. His Sun is actually square his Moon suggesting that his parents were in conflict when he was born, that will always be a source of internal conflict, but this also spurs him on towards great achievement. Deep in Bush's soul you will find an overwhelming need for peace, love and the approval of others (Libra) while the face he shows to the world is one of fierceness, independence and courage (Aries).
Sometimes the 10th house is more obvious like in Willie Nelson's case. He has musical Taurus on the 10th house cusp with its ruler Venus conjunct the Midheaven strongly suggesting a career in the arts (Venus), probably music (Taurus). He has performance oriented Leo rising with its ruler the Sun (creativity) also conjunct the Midheaven in musical Taurus. Saturn square the Midheaven suggests a long hard road, but Jupiter trine the Midheaven ensures eventual success. If an astrologer were to look at young Willie's 10th house, say in 1950, there's a pretty good chance that he would be able to foresee and foretell Willie's eventual success and even stardom in the music business.
Willie is kind of "Taurus personified" for me in a lot of ways. He's got that really earthy look and lifestyle: I consider playing guitar and smoking marijuana to be very Taurean activities. Plus he's a rock (What is he? 105 now?) and he's still doing what he was doing 40 plus years ago. All this apparent simplicity blossoms out of a profoundly deep, emotionally intense Scorpio foundation (IC) re-emphasized by his watery Cancer Moon, I think the saying "still waters run deep" applies quite fittingly to Willie.