I know it works because I've created iTunes accounts in various countries where I don't live, without entering any credit card info in any of them, because I don't have credit cards there. I generally buy free apps from those stores, or if I want to pay, I get a friend to buy me an iTunes gift card in that country. (You also can buy online, but I find that less appealing.)
Once you buy apps from other countries, free or otherwise, you can update them only while signed into those specific accounts. And even if you have the apps, some apps for streaming won't allow you to stream if you're in another county. At that point, you can decide whether it's worthwhile for you to subscribe to VPN, which hides your IP address.