Yes, if you're visiting, you'll need to have an International Driving Permit (IDP) along with your legal driving license. If you're a resident of Italy, you will need to obtain an Italian driving license after one year of becoming a resident.
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Driving in Italy can be intimidating for a foreigner, but it is safe if you prepare and follow Italian rules. While it is easier to travel between big cities by train, sometimes renting a car is the best option.
While renting a car isn't necessary or even advised if you're only visiting major tourists city (you can't even bring your rental car into the old town Florence, and having a car in Rome is a very bad idea not just because of traffic but also because many main attractions are only accessible by foot anyway), if you ...
Whether you're American or Canadian, your passport and driver's license are all you need in most European countries. However, some countries also require an International Driving Permit (IDP). An IDP is an official translation of your US license (making it easier for the cop to write out a ticket).
What are the driver's licence requirements for car hire in France? All drivers must produce a full, valid driving licence. Non-EU licence holders are required to have an international driving permit if the licence is not in French. All renters must produce photographic ID - this can be a passport or driving licence.