Italy coach Nick Mallett and his USA counterpart Eddie O'Sullivan have both shown how desperate they are to win the match between their teams on Tuesday by naming their strongest sides.
Mallett has made nine changes to the side that defeated Russia 53-17 last Tuesday, while O'Sullivan has made 14 changes to the team that lost 67-5 to Australia on Friday.
Italy captain Sergio Parisse keeps his place for a third successive match, while Tommaso Benvenuti plays his third match, but switches back to the wing after starting at centre against Russia.
Luke McLean has replaced Andrea Masi at full back, after the latter was forced to withdraw because of a calf injury. McLean's place among the replacements is taken by Giulio Toniolatti.
Despite scoring nine tries against The Bears, Mallett was more concerned with the three they conceded which is why he returned to the backline that started their opening match against Australia.
"We have only four games and we have to win three," Mallett said. "I had a look at the players against Russia and there were a lot of defensive errors.
USA target Italy
"It was the same backline that played Japan and to concede three tries against Japan and Russia isn't good enough. If this backline had played against Russia, we would have scored just as many points, but conceded far fewer."
Coach O'Sullivan said USA's match schedule led to a strategy of targeting particular fixtures, meaning they rested the core of their team for their clash with Australia.
But Tuesday's match has been earmarked as a chance to upset a tier-one rugby nation and O'Sullivan has responded by naming his strongest line-up - the same 22 that defeated Russia 13-6 earlier in the pool stage.
“We knew coming into the World Cup with our schedule that we had to target particular games,” he said.
“So we picked the Russia game as the one to win, Italy as another one to target and we rolled the dice against Ireland given the occasion.”
Flanker Todd Clever has reclaimed the USA captaincy while prop Mike MacDonald will set a new Eagles record by appearing in his 11th Rugby World Cup match.
With Italy expecting a huge challenge to come from USA's pack, Mallett has retained two of his most experienced forwards.
Mauro Bergamasco will win his 87th cap after returning to the team against Russia while Salvatore Perugini is in line for his 82nd.
Bergamasco will be particularly important to Italy's attempts to continue the expansive rugby they played against Russia and will be hopeful of adding to his 14 test tries.
"Mauro is probably the most in-form of all the players and is very quick around the field," Mallett said.
"He was also our best defender against Russia and we need Mauro to play well against the USA to keep up the competition ahead of the match with Ireland."
While the Eagles have singled out the fixture as a time to put their best XV on the field, O'Sullivan is still realistic about his side's chances in their final match at RWC 2011.
"I'm not saying we'll beat Italy. That would be an arrogant thing to say, but I think we can test Italy and see what they've got,” he said.
"We know we're on the flight home on Wednesday morning, so if we can turn in another big performance against a tier-one nation, as we did against Ireland, that'd be a perfect way for us to finish our World Cup.”