Game play begins by placing a bet of one or more credits, by inserting money (or in newer machines, a barcoded paper ticket with credit) into the machine, and then pressing a Deal button to draw cards. The player is then given an opportunity to keep or discard one or more of the cards in exchange for a new card drawn from the same virtual deck, after which the machine evaluates the hand and offers a payout if the hand matches one of the winning hands in the posted pay schedule.

On a typical video poker machine, payouts start with a minimum hand of a pair of jacks. Pay schedules allocate the payout for hands based partially upon how rare they are, and also based upon the total theoretical return the game operator chooses to offer.

Some machines offer progressive jackpots for the royal flush, (and sometimes for other rare hands as well), thereby spurring players to both play more coins and to play more frequently.

Video poker machines operated in state-regulated jurisdictions are programmed to deal random card sequences. A series of cards is generated for each play; five dealt straight to the hand, the other five dealt in order if requested by player. This is due to a Nevada regulation, adopted by every other state with a gaming authority, that if dice or cards are used for an electronic game, the electronic versions must be as random as the real thing, within computational limits set by certain tests that are performed by gaming authority agents. It is unclear whether all video poker machines at Indian gaming establishments are subject to the same Nevada-style regulations, as Indian casinos are located on property that is sovereign to the tribe which holds the gaming license.

Newer versions of the software no longer deal out all 10 cards at once. They now deal out the first five cards, and then when the draw button is pressed, they generate a second set of cards based on the remaining 47 cards in he deck. This was done after players found a way to reverse-engineer the RNG cycle from sample hands and were able to predict the hidden cards in advance.

Newer video poker machines may employ variants of the basic five-card draw. Typical variations include: Deuces Wild, where a two can serve as a wild card and a jackpot is paid for four deuces or a natural royal; pay schedule modification, where four aces with a five or smaller kicker pays an enhanced amount (these games usually have some adjective in the title such as "bonus", "double", or "triple"); and multi-play poker, where the player starts with a base hand of five cards, and each additional played hand draws from a different set of cards with the base hand removed. (Multi-play games are offered in "Triple Play", "Five Play", "Ten Play", "Fifty Play" and even "One Hundred Play" versions.)

In the non-wild games (games which do not have a wild card) a player who plays five or six hundred hands per hour, on average, may receive the rare four-of-a-kind approximately once per hour, while a player may play for many days or weeks before receiving an extremely rare royal flush.

When certain pay schedules are offered by a video poker machine, players using perfect or near perfect strategy can obtain greater than 100% payback over a sufficiently long period of play. These machines are referred to as "full pay" machines. Casinos place full pay machines alongside other machines with pay schedules that offer a negative return, so it is up to the player to properly identify which video poker machines offer the full pay schedules.

Most full pay machines are configured with a pay schedule that is only full pay when the maximum amount of credits is bet. (See the pay schedule tables later in this article for details.)

Deuces Wild

One variation of video poker, called "Deuces Wild", can be found with pay schedules that offer up to a theoretical return of 100.762%, when played with perfect strategy. It is also available with other pay schedules that have lesser theoretical returns:

* Notice the gap between the payoff for a Natural Royal Flush played with 4 credits vs. one with 5 credits. The payoff schedule for most video poker machines has a gap like this, such that players who do not play with the maximum number of credits at a time are playing with a negative theoretical return.

Double Bonus

Another variation of video poker, called "Double Bonus", can be found with pay schedules that offer up to a theoretical return of 100.1725%, when played with perfect strategy. It is also available with other pay schedules that have lesser theoretical returns:

* Notice the gap between the payoff for a Royal Flush played with 4 credits vs. one with 5 credits. Players who do not play with the maximum number of credits at a time are playing with a negative theoretical return.

Double Double Bonus

Another variation of video poker, called "Double Double Bonus", can be found with pay schedules that offer up to a theoretical return of 100.067%, when played with perfect strategy. It is also available with other pay schedules that have lesser theoretical returns:

* Notice the gap between the payoff for a Royal Flush played with 4 credits vs. one with 5 credits. Players who do not play with the maximum number of credits at a time are playing with a negative theoretical return.