Hearing "How are you?" at a grocery store or a fast food place was a kind of culture shock for me when I visited the USA from Europe. I did not know how to answer either, you have to be accustomed to it to find it normal, when a simple "Hi, may I help you" would work
It's a little weird at first, but I like it. I'm from Switzerland and I've lived all over the world before settling here in San Francisco. A simple exchange of "Hi, how are you today?"—"Great, thanks, how are you?" and a smile before you order your latte makes life a lot more pleasant. I definitely miss it when I travel now.
