As mentioned, in some of the smaller outlying towns ..or in some of the small little boutique shops I would agree that AMEX and in many cases credit cards in generally are not readily accepted. It is much better than it used to be. However, in trying to answer the topic question in the spirit it has been asked, I would again say that the ability to use AMEX in most International cities is not a big problem..and is probably not a problem at all at hotels, nice restaurants, and most shopping. Since, Amex is the only card I have, I have conditioned myself to look ask if AMEX is accepted if I have any doubts. I hate to be redundant, but I have had little to no problems to use Amex. At least that is my international experience.