This has come up a couple times for me. My most frequent repeated flight is to KBIS, whose main runway is 13-31. The direct course is 110 degrees. So when I get there, I come in slightly on the southwest side of the runway. If the winds are out of the northwest and the tower were closed, it would be an easy set-up for left downwind for runway 31. But when I file IFR and the winds are out of the northwest, it seems typical to be cleared for the visual approach, handed off to tower, and cleared to land on runway 31, all while I am still pointed southeast. I asked tower if they want me to make left downwind for 31 before accepting the landing clearance, and they were fine with that. But I want to ask: What is ATC actually expecting a pilot to do when he is cleared for a visual approach to and landing on a runway for which he is currently in a roughly opposite position? I can think of numerous ways to get to the approach end of the runway from there, but if nobody says anything and I don't ask for clarification, what are they going to expect from me?