To start the game, the players make their bets according to the table minimum. The dealer shuffles the cards and deals out seven stacks containing seven cards. This is done no matter how many players there are. The Banker shakes a cup containing three dice to determine who gets the firsthand.

The player looks at the seven cards and sets them into a two-card hand and a five-card hand. There is a place marked on the table to place your hands. The two-card hand is placed in front and the five-card hand is placed behind it. If both of your hands beat the Banker's two hands you win. If one of your hands beats the Bankers and one loses it is a push and there are no winners. If either of your hands has the exact same value as the Banker's hand it is a tie, which is called a copy and the Banker wins.

When you are setting your hands, your five-card hand must be a higher value than your two-card hand. If you make a mistake and the two-card hand is higher it is a "foul" and you lose automatically. When the casino acts as the Banker the dealers must set their hands according to certain rules, which is called the "House Way." If you are unsure of how to set your and you can ask the dealer to set it the "House Way." This will keep you from making a mistake.

Pai Gow is a slower paced game. There are many pushes. The Banker has a slight edge because it wins the copies.