I rent cars in the US and Canada with my San Pedro license and have never had a problem. My license (the past 3 years) even had me marked as Male. (I'm female, by the way) I was even pulled over by the Austin TX Police a couple months ago, and he never even commented on my license. (Although I think I saw a snicker)
I usually rent from Hertz, Avis, and Thrifty.