I use cash, because I have a US dollar account, so I can just put any left-overs back there. If you choose that method, however, do not get the account at BMO. I can't access the funds from the US, must make a cash withdrawal before leaving Canada, which isn't helpful if you want access to a larger amount. My friend has a US account with RBC and she got a debit card that works in the US and accesses her US account.
It's not the US, but a few years ago, I tried three different methods while travelling in Barbados - exchanging cash, using a credit card, and using my debit card to withdraw from a local ATM. The debit / ATM gave me the best rate, by far, for transactions.
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