Depends what you apply for and how willing you are to risk going unmatched. Nobody is forcing you to apply to a speciality that you can't see yourself doing, but it does help to have some kind of a safety plan if you are gunning for something competitive.
I think it all comes down to - rank every program that you would rather match to than go unmatched. And the answer to that is different for everyone.
But you have to go into medical school with the awareness that you may not be able to match to something super competitive. It's just part of the process.