The game follows the rules and nuances of the community card game Texas hold 'em. Before starting a game, the player chooses an avatar to represent themselves at the table. The player is also able to select a tell that their avatar reveals throughout the game in attempts to confuse opponents. When it is the player's turn, they can call, raise bets, go all in, or check using the bottom touchscreen of the Nintendo DS.
While the player progresses through the game and win tournaments, additional avatars and new locations are unlocked. Despite the game's name of Texas Hold 'Em Poker, a variety of other poker games are also included, such as five-card stud and five-card draw.