If you get in the position where you have to scramble, ask if the program has a history of keeping prelims on for categorical spots. I went through the pain of scrambling and it is tough. Pick a respectable program so that if they don't have something for you the next year, at least you will have a year of training at a good program, which will look good when applying to PGY2 spots elsewhere. My PD told me when we talked during the scramble that they have kept about 1/3 of the prelims each year. It is a small program with about 3-5 prelims per intern year. Some stayed on because the program expanded. Others went into Urology at the same program. And a few filled holes when a categorical or 2 left for personal reasons. Some programs also have things in the works to expand, which takes like a year to get finalized. A program that is planning to expand the next year may keep you on for the expanded 2-spot if you impress them enough.
It is all about being in the right place at the right time, and putting in a little hard work.
Good luck with the match, but if it doesn't work out, have faith because you can still end up in a good program despite taking a swing and a miss the first time around. I did. Let me know if you have questions.
