The five-card hand's rank must exceed that of the two-card hand, and it is for this reason that the two-card hand is often called the 'small', 'minor', 'low' The object of pai gow poker is to create a five-card poker hand and a two-card poker hand from seven cards that beat both of the bank's hands. Each player attempts to defeat the banker (who may be the casino dealer, one of the other players at the table, or a player acting in tandem with the dealer as co-bankers).

It is played on a table set for six players, plus the dealer. The game is played with a standard 52-card deck, plus a single joker. The game of pai gow poker was created in 1985 in the United States by Sam Torosian, owner of the Bell Card Club. Pai gow poker (also called double-hand poker) is a version of pai gow that is played with playing cards, instead of traditional pai gow's Chinese dominoes.