Steph's comment should have been a huge warning sign to this year's class, but some how I think a lot of SGU students have fallen under the impression (perhaps from prior classes success or simply the illusion of the number and quality of programs they were interviewed by) that we are no longer considered IMGs or that there was a vast difference between SGU and Ross, AUC, Saba in the eyes of Program Directors.
I am aware of several classmates that shockingly didn't match into Medicine or even Pediatrics. The problem I suspect in at least some cases(especially since some admitted it), is that these individuals turned down pre-match offers from strong community programs or slightly less competitive university programs, with the expectation they would get their top choices despite only being average to mediocre SGU students (B's with 80's on boards). This impression was further fueled by all the talk by US students that they should not rank programs they wouldn't be happy attending. Worst of all were the individuals who told me that they couldn't understand why they got their last or very low choice program when they ranked the Pre-Match offer programs higher. As an FYI, for the most part if a program offers you a Pre-Match (ie. Lutheran, LICH, Methodist, Maimonides, St. Barnabas, etc), please realize they have no intention of ranking you if you turn the Pre-Match offer down. It's sad, but thems the apples.
Sadly, if you didn't match, most of the students I know in this situation would rather have matched in retrospect at unhappy programs than take a year off or deal with the truly discouraging Scramble process. The Scramble is a bad solution at best to a poor outcome from a convoluted matching mechanism, but it is heavily weighted in the favor of US students. Scrambling in the past may have met with success by average or above average IMGs, but it seems that there is a clear preference for US and then and only then FMG's or IMG's with high 90's as the pool becomes more competitive each year.
My net two cents is this: Be honest with yourself and where you stand with respect to US students and your classmates. While it may be good to aim high, don't lose sight of the ground (ie. put solid back ups on your rank list).