Sometimes this game is played with a special "Old Maid" deck of cards. However, if you are using a standard deck, remove three of the queens before dealing. The remaining queen, often the Queen of Spades, is the Old Maid. The players pick up all their cards and put down any pairs, making sure no one else can see the cards they're holding. The player to the dealer's left starts by picking a card out of the hand of the person to her left. If that card matches one she already has, she puts the pair down; if not, it stays in her hand. A match must be the same number such as two "3s" or two "jacks".
The next player does the same thing, and so does the next until there are no more pairs to be made. As each player runs out of cards, he gets to sit back and enjoy, knowing he won't get stuck with the Old Maid. The game ends when the queen is the only card in play. The person holding the "old maid" loses the game.
In one variation, the Old Maid is the Jack of Spades. The Jack of Clubs should be removed before playing. Matches are made with similar cards but red must go with red and black with black. In other words, you can only match a 3 of hearts with a 3 of diamonds, not with a 3 of spades or clubs. Thus, since the Jack of spades has no counterpart, someone will be stuck with it.