[damncabbage]

  That's not really true. Yes, it is more work than "include 
  this Javascript file and you can accept payment" (aka 
  Stripe), but if you are prepared to do some work it isn't 
  that big a deal.

It is if you want to display your prices in US Dollars to American visitors: http://blog.angrymonkeys.com.au/why-being-an-aussie-startup-... (with discussion here: http://news.ycombinator.com/item?id=3098224 )

Summary: You CAN do it if you have enough cash.

(This post also addresses the PayPal point. You're stuck with Payflow Pro, which is much pricier, especially for a bootstrapped startup.)

  (Also, most US countries accept Australian payment. Some 
  won't ship here, but that's a different problem)

Point.

(They won't usually quote prices in AUD, but that's much less of a problem.)