In some cases, the game server’s IP address is actually anycasted, which is an approach that (very carefully) breaks the notion that a network identity belongs to a single machine. Instead, that one IP address would actually be routed to a nearby machine which is authorized to assume the identity of the game server, and will thus handle the game traffic for that region. So long as all regions handle their traffic identically and the results are consistent as if there were one giant machine that were handling all the traffic, this can work.

In other situations, the game server IP address really is for a single machine, but that machine is a specialized hardware load-balancer that is situated in a cloud provider’s network. All that this machine does is to be the frontend for the 5-tuple, and will create a new conversation/connection 5-tuple with a cluster of game servers within the cloud provider’s network. There might be some superficial comparisons between a load-balancer and NAT, but the latter works by fraudulence whereas a load-balancer is a subcontractor.