The language / the cultural barrier isn't as high as it is for an American living in China though. I've grown up speaking English and watching a lot of American / British movies and TV, reading a lot of english literature. I assume this is not the case for most Americans with Chinese culture.
There's definitely a culture shock when you first move here and are figuring stuff out - How do you order food at a subway or a chipotle? (not a big deal anymore given the explosion of these restaurants in India in the last few years). Why is called Cilantro and not Corinander? How do I get a phone when I don't have any credit history at all? What is a turn-pike?