Apple even has a
tech note on it these days. This makes the assumption that you don't want a payment-based account (i.e. only want free stuff). If you want to actually buy anything, you're pretty much fucked, unless:
- You know people in the US who'll buy and ship iTunes gift cards to you (or just email the code);
- You know people in the US who'll send digital iTunes gifts to your account;
- You have some kind of US payment of your own (credit card, verified PayPal).
If you do decide to do this, I'd strongly recommend avoiding downloading any apps, because that turns updating into a horrible dance, especially on iOS, which gets confused if you have multiple accounts. It's also, reportedly, a nightmare when it comes to iCloud. We pretty much only ever use our US account for TV and movie rental these days, on the TV.