Once seated players are dealt either 13 tiles or 16 tiles depending on the variation they are playing.

A turn involves a player's drawing a tile from the wall (or draw pile) and then placing it in his hand. The player then discards a tile onto the table. This signals the end of his turn, prompting the player to the right to make his move. As a form of courtesy, each player is encouraged to announce the name of the tile being discarded. Most variations have a rule that stipulates that discarded tiles must be placed in an orderly fashion in front of the player, while some require that these be placed face down.

Flower tiles when dealt or drawn, must be immediately replaced by a tile from the dead wall, or if no dead wall exists, the back end of the wall. They are immediately exposed. They are exposed by being placed in view on the table on front of the player's tiles. At the start of each round, where two or more players may have flower tiles, flower tiles are replaced starting with the dealer and moving to the right. Flower tiles may or may not have point value; and in some variations, possession of all the flower tiles wins the round regardless of the actual contents of the hand.

In American Mahjong things are slightly different, Flower tiles are not instantly exposed and replaced, as they may be melded with other Flower tiles in the same group. Basically they are treated as if they were another set of honor tiles or to be used as a requirement of a winning hand. Early versions of American Mahjong used Flower tiles as Joker tiles.

Joker tiles is includes in several variations. Most often it is included in American variations of Mahjong. They may be used as a substitute for any tile in a hand. Some variations only tiles in melds. Depending on the variation, a player may replace a Joker tile that is part of an exposed meld belonging to any player with the tile it represents.

A player must never forget the rules governing discarding Joker tiles also exist: some variations permit the Joker tile to take on the identity of any tile, and others only permit the Joker tile to take on the identity of the previously discarded tile or the absence of a tile, if it is the first discard.

Joker tiles may or may not have an impact on scoring, depending on the variation. Some special hands may require the use of Joker tiles (one example, to represent a "fifth tile" of a certain suited or honor tile).

In American Mahjong, it is illegal to pass jokers during the Charleston.