I am not an IMG but have experience working along IMGs. It is very tough for a IMG to get into a program, but not impossible. The programs that tend to get IMGs are usually the top programs, not the "middle tier" ones. The latter play it safe by getting only US grads. The IMGs that match at the top programs (Mayo, Harvard are examples of programs with IMGs) are not applicants that were not known to the programs. Count on doing research for 2-3 years for a program or well-known surgeon who has the connections. You will need the connections as you probably won't have them from your medical school. Publish, present at meetings, do away rotations, etc.