I am based in the UK and publish a website, with Google Adsense ads, aimed at readers in the USA.
I have been using the Google Adsense Preview Tool, set to the United States option, to see what ads are being served to my readers in the USA. The preview tool has been showing, to my surprise, that at least half the ads are for UK websites (with .co.uk domain names).
For a reality check, I phoned a relative living in New York City, and he kindly viewed six of my pages. He found that all the adsense ads being served in the USA were USA websites (ie with .com domain names).
This was reassuring. However the lesson I have learned (which I thought I should pass on) is that you can't trust the preview tool in these circumstances.