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Pai Gow starts with each player placing their own bet. The order the cards are dealt in is determined randomly by the dealer, who then deals each player 7 cards from a 53 card deck containing the usual 52 card poker deck plus a single Joker. In online pai gow, this is handled electronically through a specialised online pai gow room.

Many of the cards and five-card hands in pai gow are the same as in most other poker games. The possible exceptions are:

• The use of the Joker may vary, so be sure to find out which rules the room you are playing in uses. For many games of pai gow poker, the Joker may be used as an Ace in order to complete a straight, a flush, or a straight flush. In some games, it may simply be equivalent to an Ace. Many casinos only allow the Joker to act as an Ace in the two card hand, but occasionally the Joker may be wild without limitation.
• When playing pai gow in some casinos and in some versions of online pai gow, the hand A/2/3/4/5 is placed higher than K/Q/J/10/9 and lower than A/K/Q/J/10. This variant is not universal, and is notably avoided in many casinos in California.
• Due to the Joker representing an Ace, it is possible to get a five-card straight in pai gow. This outranks the Royal Flush and is the highest ranked five-card hand in pai gow.

Other than these exceptions, the ranking of five-card hands in online pai gow is the same as for 5 stud poker. The order of the ranks from high to low in pai gow is thus 5 Aces, Royal Flush, Straight Flush, Four-Of-A-Kind, Full House, Flush, Straight, Three-Of-A-Kind, Two Pair, Pair, Nothing.

The best two-card hand in pai gow is a pair. One of the interesting rules of pai gow is that the two-card hand must not be of a higher value than the five-card hand. There can be penalties for not arranging your hands correctly in pai gow. This can range from being forced to rearrange your hand in a particular way through to an automatic loss. Some online pai gow rooms may warn you of a possible foul hand before you play it, though it is best not to rely on it.

In order to win a hand of pai gow, the player must beat both of the dealer’s hands. If one hand wins and the other loses, then the player pushes and no money changes hands. In the event neither hand beats those of the dealer, the player loses, and their stake goes to the dealer. Anytime the dealer and player tie on a particular hand, the dealer wins that hand.

A winning player is paid even money on their stake, but casinos may require a 5 per cent commission on wins. Some casinos merely charge a flat fee per hand played, though. When playing online pai gow, it is advantageous for players to try many different online pai gow rooms to guarantee the best price per hand.