The US has a very good record against Paraguay having 2 wins, 2 draws, and no losses. They have blanked Paraguay three times in these 4 encounters. However, this is not a toothless Paraguay that they are meeting. Roque Santa Cruz and Salvador Cabanas combined for all five goals as they ran rampant against a wide open Colombian defense, turning them inside out in a sprint to the races.
The US defense has more mettle than Colombia and so it will be left to Jimmy Conrad, Jay De Merit, Jonathan Bornstein, and probable starter Danny Califf to shackle Roque, Oscar Cardozo and Cabanas. Marvel Wynne was ineffective with Ben having to clean up against Argentina as the defense broke down in the latter part of the second half. The US will have to close the passing lanes very quickly which medio Edgar Baretto and Julio Dos Santos will try and create.
On the other hand, the US will have to rely more than the long ball to Eddie Johnson to create chances. As many commentators pointed out against Argentina, the US suffered mightily from shoddy and disjointed wing play resulting in inaccurate crosses and passes that went no where. The attack will again go through Benny Feilhaber, fast developing into one of the USA's most promising talents and Ricardo Clark on the left. Ben Olsen as the holding midfielder should push up the speedier Bornstein and DeMerit down the flanks opening up the field to try and get some quality wing play. The US against the Argentines could not mount any credible threat due to a lack of set pieces like corners and free kicks. They should be able to get more against the Albirrojas.
I think corners and free kicks is where the taller US players will get an edge over the Paraguayans as well as the selective long ball to Eddie Johnson. The question is whether the US will be able to come up with effective service up front.
The Paraguayans have a superior goal difference which will give them an advantage if the US should tie them in points. So the US need at least a tie and then take their chances against the Colombians to keep their chances alive.
Prediction: Paraguay 2 USA 2.