South Africa drives on the left — and an International Driving Permit (IDP) is recommended.
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South Africa drives on the left-hand side of the road.
Not strictly, but it's recommended. South Africa accepts a valid US license if it includes a photo and is in English, but strongly recommends carrying an IDP too.
In the US, an IDP is issued by AAA or the National Auto Club — it costs around $20, requires a passport photo, and can't be obtained after you've already left the country.
No — an IDP is a translation document, not a standalone license. You must carry your regular US driver's license alongside it at all times.