A dice shaker containing three dice is used to determine who receives the first hand. The casino dealer will shake the dice cup, remove the lid, and announce the total of the three dice. The position of the dealer is number one. The playing position to the right of the dealer is number two, the next position is three continuing counterclockwise around the table. The casino dealer's position is always considered number one, eight and 15. Keep in mind that all six player positions are used in the counting process whether or not a player is actually seated and playing (all empty and full player positions are counted). If the three-dice total is 14, the sixth wagering position (first player position to the left of the dealer) would receive the first card.

Once the determination is made as to who receives the first card, the dealer will deal the cards face down to each player position so that each player and the dealer receives seven cards. The dealer will remove the cards from those player positions where there is no wager and then check that there are four undealt cards left (indicating a valid deal).

The players may then pick up their cards and arrange the cards into two-card low hand and five-card high hand.

It is very important to remember that the five-card high hand must be higher in rank than the two-card low hand, otherwise it results in an automatic losing hand. For example, if the player's two-card hand contains a pair of Ss and the five-card hand contains only a pair of 3s, the hand was not set correctly and automatically loses. In this particular example, if the two-card hand contains a pair of Ss, the five-card hand must contain as least a pair of 6s or higher in order to be arranged properly.

This is the most important rule to remember when playing pai gow poker: The five-card hand must be higher than the two-card hand.

Each player is responsible for arranging his cards into the best high and low hands. Once this is done, the players place their two hands face down on the appropriate area of the layout (the two-card low hand is placed closest to the dealer, and the five-card high hand is placed behind the low hand and closer to the player).