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Head Coach Mike Tolkin will likely sit down with attack coach Tony Smeeth and work up a better offensive approach. Eighty points in seven games will not do the job, and Smeeth has to be under scrutiny for how the offense - usually with a lot of possession - has performed.
Smeeth has to find something that gets the ball over the line - and it seems obvious that getting more runners surging onto passes from the rucks would make sense. The USA attack near the tryline is too static, and too unimaginative.
The players are also under pressure. Twice, now, Folau Niua has entered the game late, taken over flyhalf, and energized the offense. If players knew more about how he plays, some of his breaks could well become tries. Even if Niua has 7s responsibilities, he has made an excellent case for himself to be the USA 15s flyhalf. Toby L'Estrange played better against Canada, but his form has been off all year.
Don't forget Adam Siddall is still in the mix.
Chris Wyles did well at outside center, and with Blaine Scully playing so well at fullback, and poised to improve as he plays for Leicester this fall, the outside backs could be set.
In the forwards, the big question seems to be whether Peter Dahl can handle the openside position. He has not become the ball-poaching machine he needs to be, but he gets involved i a lot of rucks. Can he build on that work rate, or does someone like Cam Dolan step in?
Up front, Titi Lamositele will only get more minutes, while Eric Fry will not. Fry just doesn't have sufficient lateral agility, and it has been a rough year for him. Lamositele not only got his foot in the door, but is shoving it open. He is only 18, but he plays with much confidence, and physically he will only get stronger.
And finally, should Todd Clever be the No. 8? That's what he wants to be, that's for sure, but he has often played his best as a #7. If Samu Manoa is on the squad, his strength and power on the pickup might be a welcome asset.
With the USA probably good enough to beat Uruguay comfortably in next year's second round of RWC qualifying, now is the time to make changes in both the playing and the coaching.