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I'm in Canada and have gotten around that by buying US app store cards and setting up a US account to make purchases. I end up switching from one to the other account when it's time to update apps etc. but it works well for the most part. Since I'm using "cash" (in the form of the cards) I have a McDonalds address in the US instead of my real one. For accessing georestricted items like books, I use a vpn with a US ip address so that when I connect, iTunes sees me as being in the US.
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