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Pai gow poker uses a joker, so this means there are 53 cards in the deck. However, the joker is not a true wild card. It can be used to complete a straight, flush, or straight flush, otherwise it is an ace. The object of the game is for a player to create two poker hands out of the seven cards in his hand: a five-card poker hand and a two-card poker hand. The five-card hand must rank higher than the two-card hand. The two-card hand is often called the hand "in front" or "on top", and the five-card hand is called the hand "behind" or "bottom", as they are placed that way in front of the player when he is done setting them.

In Pai Gow, you play against the dealer, and both of you will be trying to make the best possible hand. Every round begins with the player making a bet. You get seven cards initially. You then group the cards into two hands, a five-card hand (which must be the high hand) and a two-card hand (which must be the low hand). The ranking of the five-card hand is the same as in poker, except that a straight of A-2-3-4-5 is the second highest straight.

The dealer sets his hands according to the "house way" once you have grouped your cards. Then the two five-hand cards will be compared. After that, the two-hand cards will be compared. The highest hand will win in each case. The player is paid with even money, less a 5% commission, if both of the player's hands beat both of the dealer's hands. The round is considered a push if the player wins one hand, but loses the other to the dealer. The player will lose the entire wager if he or she loses both hands. The dealer wins tie hands.

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