Although the game has existed since the early 1960s, its popularity has risen since the early 2000s as a result of concerns that nine-ball has suffered as a result of flaws in its fundamental structure, particularly the ease with which players can often make balls from the break.

The World Pool-Billiard Association (WPA) standardized rules for ten-ball are very similar to those for nine-ball, but with key changes to increase the difficulty of the game.

In contrast to nine-ball, it is slightly harder to pocket any balls on the break shot with the more crowded rack, the initial shooter cannot instantly win the game by pocketing the 10 on the break, all shots must be called, and performing a string of break-and-runs on successive racks is statistically more difficult to achieve.

If the 10 ball is pocketed on the break, it is placed back on the foot spot and the shooter's turn continues.

Any other balls that are pocketed on the break stay down, with the shooter continuing their turn, unless a foul was committed.