Many bloggers can and do make a living or earn side income without using Adsense.
Bloggers can sell Ebooks they've written, sell direct ad space,use affiliate ads and there are other Ad networks for publishers out there that pay just as good if not better than Adsense if you have the good traffic.
Media.net is another Alternative to Adsense and lots of big websites earn money through them so they're legit.
You just need quality traffic and majority of your quality traffic should be from USA.