Drivers liscence requirements in Italy

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You're supposed to get an International Drivers License at AAA. I think some have gotten by without but it would be my luck that my rental company would stick to the rules so I make sure I have an international license when I travel to Italy.

BTW, if you're even thinking about driving in Rome don't do it. It's not a city for an American to drive in.

I used my USA license and passport no trouble.
That was 5 years ago, but I doubt any laws have changed.

You go down to the AAA office nearest you, give them $20, and they give you a little paper booklet that is your license info translated into various languages.

Preface: we did 1200 miles via car, Rome to Palermo and back, in February. Regarding driving in central Rome--it's congested, with many pedestrian only, one way, and randomly cut off streets that make navigation a challenge. If you are comfortable driving in a congested/cramped US city, you will be fine in Rome as long as you KNOW WHERE YOU ARE GOING. Do not rely on Google Maps, as we found them to be inacccurate with regard to pedestrianized areas just two weeks ago. Spring for the in-car GPS, or use a dedicated GPS, as those maps are more accurate. Have a decent paper map as a backup, and plan out your routes before leaving town.

Also, the Italian autostradas are not as logically designed and clearly marked as US interstates (or German autobahns or French highways). So if you miss your on ramp or offramp, you may not find an easy do-over or cloverleaf to return you to the starting point. It helps to do a little orienteering in advance.

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You go down to the AAA office nearest you, give them $20, and they give you a little paper booklet that is your license info translated into various languages.

Preface: we did 1200 miles via car, Rome to Palermo and back, in February. Regarding driving in central Rome--it's congested, with many pedestrian only, one way, and randomly cut off streets that make navigation a challenge. If you are comfortable driving in a congested/cramped US city, you will be fine in Rome as long as you KNOW WHERE YOU ARE GOING. Do not rely on Google Maps, as we found them to be inacccurate with regard to pedestrianized areas just two weeks ago. Spring for the in-car GPS, or use a dedicated GPS, as those maps are more accurate. Have a decent paper map as a backup, and plan out your routes before leaving town.

Also, the Italian autostradas are not as logically designed and clearly marked as US interstates (or German autobahns or French highways). So if you miss your on ramp or offramp, you may not find an easy do-over or cloverleaf to return you to the starting point. It helps to do a little orienteering in advance.

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all of this. I drove from Monaco to cinquterre. It was awesome.

The international driver's license is literally just a $20 piece of crap that they write your USA license info on and it translates your license to multiple languages. I've rented a car 3 times and they've never asked for mine, so it's been pointless. But as said if you have a AAA office near you it's a piece of mind I guess.

I absolutely love driving in Italy. They are absolutely crazily offensive drivers. It's a blast, and they drive much faster than anywhere else I've been.

Definitely as Hungryone said, make sure you know your way beforehand. Everytime I've rented a car in Europe it's had a built in gps for no upgrade, but I wouldn't plan on that. Hungyrone is also definitely right that you don't want to miss an exit.

Their interstate there also has literally no median for much of it. They have an area to pull a vehicle over about 100 yards long every like kilometer or two. It's intimidating as hell being next to semi truck after semi truck and having nothing but 1ft between your mini car and a concrete barrier for miles and miles at a time.

Eta: I'm sure you know this, but don't rent your car until the last day you leave your first city. Don't plan on parking anywhere, even at hotels. The hotels in the city will likely have a parking 'plan' but it's often in a 3rd party lot and depending on the time of year that can be down the street a ways from your hotel and cost money.

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Gonna rent a car in Italy

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If you are going south of Rome, look out!!!! Unless you have been to Bangkok you can't imagine the rules (or lack there of) on the roads.

I had a '92 Camero in Sicily for two years the locals called it the Grade Porsche, but had more than one Italian handshake (bumping mirrors as you pass on the road.)

I am renting a car in Tuscany in 2 weeks. Got an International Driver's Permit from AAA.

I only drov in the piedmont region of the alps for a few days during our 3 week trip. Toured wineries and hiked in the mountains. It was awesome

It is a gorgeous drive, though narrow and very twisting. I got motion sick, and that generally doesn’t happen to me.