Tel Aviv is just as cosmopolitan as most large European cities. It is also just as EXPENSIVE or more.
Israel is very different culturally from the US and many Americans, who know they will be there temporarly, give up trying to "integrate" and just live in small "all American enclaves". This also helps them not to feel linguistically isolated, as Hebrew is a hard language to learn even at the basic level, even more so at the level that one would expect from a professional student. Most people will be able to give you basic directions in English and a many of the young people will be able to hold a basic concersation with you (actually, the younger crowd loves a chance to practice their English, which will make learning Hebrew even harder). I would not expect to hold a very complex dialogue in English with the average Israeli though, and if you crave intellectual conversations, your US buddies at school will be it. But you will not get lost, nor have any problem shopping or conducting any daily chores in English. DO NOT expect your "patients" to know enough English for you to figure out accurately what is ailing them...
There is much to see in Israel, if you are a history or anthropology buff, although med school may leave you with limited time to explore. If anthropology, archeology and history are not your favorite pastime, but you are the "sports" type, Eilat and the Sinai have GREAT scuba diving.
The food is good, and you can find any type of cuisine which appeals to you, but I truly enjoyed the real Middle Eastern cuisine. Again, expect the price of food to be comparable or higher than here in the States. Red meat is very expensive in Israel, and most people will stick to chicken and just have red meat once a week or so. Forget pork, it is mostly a kosher country as food is concerned and pork is hard to find and expensive (it doesn't help the "other white meat" lovers than the Muslims do not eat pork either).
Rents in Tel Aviv are moderately high...
Expect to receive a first class education as the educational system in Israel is a few light years ahead of us here.
Good luck and have fun!
