Listen to VentdependenT about the big cities and big programs being the most competitive. If you're a decent student, you'll definitely get a spot as long as you aren't picky about both reputation and location.
I considered myself an average to above average applicant. Step I 232, mostly high pass in third year, all honors fourth year, research and two abstracts in anesthesia. I applied throughout the Northeast and matched at Penn (my first choice). I also got a really good feeling from Hopkins.
For me, reputation was just slightly more important than location. I considered staying in New York, but realized that Iwould probably have to settle for a lesser reputation school (if I matched at all).... NY and CA can be really tough.
Also, don't be discouraged if you're shot down by programs.... it's really about making a good match of your personality/interests and the program's. Apply broadly and you WILL find a good school that likes you.
Good luck! Confidence goes a long way.