The original game of Gai Pow was a game played using Chinese dominoes. Gai Pow has been a popular game in China for thousands of years despite it's complexities. The dominoes are divided into both military and civilian suits, both having specific names and symbols for each tile. Much of the rules and strategies are passed down orally through the generations rather than having a set of written instructions. This makes Pai Gow a very difficulty game to learn for anyone of another cultural background.

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As with Keno, the Chinese immigrants brought Pai Gow sets along with them while working on the American railroads in the mid-1800s. Finding that the Americans also enjoyed gambling games, the traditional Chinese game was slowly merged with poker and played with cards instead of the symbolic Chinese tiles that the Americans didn't understand.

Although Pai Gow Poker has been around since that time, it didn't show up in casinos until 1987 when a Vegas casino introduced the game to its patrons. The game quickly caught on due to the already large Asian population in the area and showed up in Atlantic City casinos the following year. As with other popular casino games, Pai Gow Poker has been a big hit for online casinos, as well.