I'm just starting this, but I feel that actually flying visual is surprisingly easy.
I'm currently trying to do the MacRobertson race to Melbourne by visual flying only.
The first three legs turned out so easy (though there was some bad visibility in france) that I removed the ADF from the panel yesterday.
Big rivers are easiest to follow (ocean shorelines are easier still of course), then in decreasing order of preference railways, double lane motorways. Most of these will be pretty accurate even with the default scenery.
With a LOD9 (76m) mesh topography gets very realistic, so navigating in mountains becomes pretty easy as well.
Big towns are also likely to be present, even with default scenery, but I would use them just for back-up to confirm position, or to keep track of position during the flight.
Otherwise fly a course to hit a line feature (big river, railroad, mutorway, mountain ridge, shore, ...) to the side of a landmark, and follow the line feature to the landmark (river bend, airport, road/railway crossing, ...). See fsaviator's propliner tutorial at Calclassics, Chapter 1A - Phase 1.
You may want to precompute a detailed flight plan with ETE/course from waypoint to waypoint, and continuously keep track of position (finger on the map), compare ATE to ETE.
I use a world atlas for general planning (Major rivers/roads/railways/mountains). Love Tim Arnot's excellent Plan-G flight plan and map for working out the details.
I'll send you a postcard if ever I manage to get to Melbourne. :d
PS: A quick plan from Helena to Portland:
From Helena head east along 12 (mountain pass) to Hwy 90. 247° 35nm
Follow N through Missoula to characteristic bend to the North. 86 nm
Head by DR WSW to Dworshak reservoir (look out for the railway line that runs Orofino - Pierce in case you've drifted too far south.) 237° 53 nm
Follow the snake river to the Columbia at Kennewick. Approx 150 nm
Follow Columbia river through the Columbia river gorge to Portland. Approx. 158 nm
KPDX is easy to identify by some islands in the river/roadbridge.
Easy