Pai Gow Poker is played with a deck containing fifty-two cards and a joker. The joker in the pack can be used as an ace or if necessary to complete a straight or a flush. The main thing to keep in mind while playing Pai gow Poker is that you have to make two poker hands that will beat the banker’s hands. Each of the players is dealt seven cards. Using these cards they have to make a five card high hand game and a two card low hand game. Skill is necessary in dividing the two hands, as carrying this out with skill will give the house less chances of winning. The value of the different hands is the same as normal Poker. Keep in mind that the five-card hand must always be higher than the two-card hand. You win the game if both your hands are better than the bankers’ hand and lose if they are not. The banker always wins the absolute ties.

Each player spot has spaces for a bet, low hand, high hand and sometimes the house commission. The dealer deals 7 7-card hands in front of the chip tray. The banker has the option to be a player but more often than not he is usually with the house. The banker chooses which hand goes to which player by shaking a dice cup with three dice. The banker's position is 1, 8 or 15 and the hands are passed out counter-clockwise. For example, if the dealer is the bank and the dice total to 6, player 5 gets the first hand, player 6 gets the second, the dealer gets the third and so on. Don’t give too much importance to the dice, as it is more of a formality and concentrate more on the hand that you get.

Each of the players on the table has a spot for the bet, low hand, high hand and the house commission. After making the two hands, every player puts his 2-card hand in the box closest to the dealer and the five-card hand face down at the back. Once all the players have done this, the dealer turns over and sets the bank's hand. The dealer goes counter-clockwise around the table comparing the banks hand to the players, and taking, paying, or knocking. A five percent commission is given on winning bets.

The only strategy involved while playing Pai Gow Poker is how to set the two hands and how much money to bet. The most basic strategy that is considered the best is to make the highest possible 2-card hand, but which will be less than your 5-card hand. If you are confused about what to do then you have the option of showing your cards to the dealer, who will show you how the house would have played with those particular cards. Since pairs generally win the 2-card hands, and two-pair wins the 5-card hands, the only difficult decisions are when to split two pairs.