This afternoon's game (NZ time) at the 20,000 capacity Mapfre Stadium in Columbus - the capital of the midwestern state of Ohio - is crucial. The 30th ranked USA have never lost at the soccer-specific arena in 10 matches conceding just one goal during seven wins and three draws. Their overall World Cup record against Guatemala is 7-1-5 but they have won all six qualifiers at home.
American captain Michael Bradley told the Mail Online: "You have to understand that somewhere along the way, maybe twice, you're playing in a game where your lives depend on it."
The USA's German coach Jurgen Klinsmann is under pressure particularly after surprising selections in the first leg, although the former German star will be used to that.
Former American players are calling for his head if the USA lose with Landon Donovan in a pessimistic pre-match mood saying: "The sense I get, and I talk to a lot of the players, is that there's no confidence because there's no stability."
Meanwhile Guatemala will be without key striker Carlos Ruiz, who has twice won the Major League Soccer golden Boot. Guatemala's all-time leading scorer, with 59 goals, is prevented form leaving the country because he is in a legal dispute over property. The 36-year-old scored the second goal in Guatemala's win last week.
Meanwhile America's Olympic under-23 team is also in a do-or-die position today. They play Colombia in Texas this afternoon (NZ time), for the 16th and final spot for the tournament in Rio. The teams drew 1-1 last week.