I watched a video from ETA Prime using the tool, he did pretty much everything the same but set the default region to "WORLD" Going to give that a shot as a work around.
Another workaround is that one of my options before starting the rom, is to choose another region, so it's really only 2-3 extra button hits to get to USA.
Also noticed that I can select all my mame roms, right click and go to like "properties" or something, then you can change the default region, but it's already on USA.