The cards are shuffled and cut and the dealer deals the cards one at a time face down until every player has two cards. If the pot is empty all players pay the agreed ante to the pot. This might for example be set at 100 times the ante. The players need to agree in advance on the ante that all will pay at the beginning to start the pot, and it is wise also to agree on a maximum amount that can be won from or lost to the pot in a single deal. In theory as many as 26 people could play, but the game probably works best for around 5 to 10 players. A standard 52-card pack without jokers is used. If the players are somewhat reckless the size of the pot can escalate very rapidly, and the name presumably refers to the bravery required to contest one of these large pots and risk losing an equally large amount.

It is normally played with hands of fewer than five cards, and it has a different betting mechanism from normal poker - match pot betting. Guts is often played as an option in dealer's choice poker games, although it is not strictly speaking a poker game.