Forever and ever is a long time! There are no "bad" US MD schools (ok, maybe one). From what I am told, there are very few "bad" DO schools (and they may be better by the time you apply).
Admission to any of them will set you up to practice medicine in the US (should that be your plan).
As an international with a sub 500 score, the second score could make a significant difference. Therefore, under no circumstance should you take the MCAT again until you are confident of a score consistent with success. The median score for a successful international (for MD) is 512. You should be aiming higher than that to offset the other score. Admittedly, it is quite unlikely to get a score that averages to 512 given what you have told us, but "pretty good" will probably not cut it (for MD).